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<p>Frailty indices have emerged as robust predictors of morbidity and mortality following neurosurgical interventions. However, their impact on long-term functional and cognitive outcomes remains insufficiently characterised. This study evaluated the prognostic significance of frailty in patients undergoing emergency neurosurgical care and subsequent neurorehabilitation. Based on a cumulative deficit model, a validated 34-item Frailty Index (FI) was applied retrospectively to patients admitted for acute neurosurgical care at a tertiary academic centre and transferred to a specialised neurological rehabilitation facility. Perioperative clinical data, postoperative complications, and discharge dispositions were analysed. A total of 236 patients (median age: 64 years) were included, with 75 (31.8%) classified as “Fit,” 87 (36.9%) as “Semi-fit,” and 74 (31.4%) as “Frail.” Only 13 (17.6%) frail patients returned home post-rehabilitation, compared to 64 (85.3%) fit and 61 (70.1%) semi-fit patients (<i>p</i> = 0.0006). Multivariable logistic regression confirmed FI as an independent predictor of unfavourable discharge destinations (hospital or nursing home vs. home; adjusted odds ratio: 3.615, 95% CI: 1.655–5.580; <i>p</i> = 0.0094). Frailty significantly influences postoperative recovery, predicting greater disability, lower neurological and cognitive function, and unfavourable discharge outcomes. Incorporating frailty assessment into routine emergency practice and research protocols may refine risk stratification and inform clinical decision-making for acutely ill patients undergoing neurosurgical interventions.</p>

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The impact of frailty on functional recovery and discharge dispositions in patients undergoing urgent neurosurgical care

  • 期刊论文

  • 发表日期：

    2025年5月17日

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  • Leonardo Tariciotti,
  • Giulio Bertani,
  • Maurizio Lanfranchi,
  • Luigi Gianmaria Remore,
  • Franco Molteni,
  • Nino Stocchetti,
  • Marco Locatelli

摘要

Frailty indices have emerged as robust predictors of morbidity and mortality following neurosurgical interventions. However, their impact on long-term functional and cognitive outcomes remains insufficiently characterised. This study evaluated the prognostic significance of frailty in patients undergoing emergency neurosurgical care and subsequent neurorehabilitation. Based on a cumulative deficit model, a validated 34-item Frailty Index (FI) was applied retrospectively to patients admitted for acute neurosurgical care at a tertiary academic centre and transferred to a specialised neurological rehabilitation facility. Perioperative clinical data, postoperative complications, and discharge dispositions were analysed. A total of 236 patients (median age: 64 years) were included, with 75 (31.8%) classified as “Fit,” 87 (36.9%) as “Semi-fit,” and 74 (31.4%) as “Frail.” Only 13 (17.6%) frail patients returned home post-rehabilitation, compared to 64 (85.3%) fit and 61 (70.1%) semi-fit patients (p = 0.0006). Multivariable logistic regression confirmed FI as an independent predictor of unfavourable discharge destinations (hospital or nursing home vs. home; adjusted odds ratio: 3.615, 95% CI: 1.655–5.580; p = 0.0094). Frailty significantly influences postoperative recovery, predicting greater disability, lower neurological and cognitive function, and unfavourable discharge outcomes. Incorporating frailty assessment into routine emergency practice and research protocols may refine risk stratification and inform clinical decision-making for acutely ill patients undergoing neurosurgical interventions.